Urologiia最新文献

{"title":"[Efficacy of oral chemolysis in the management of staghorn uric acid nephrolithiasis].","authors":"A Malkhasyan V, U Tunguzbaev H, A Pulbere S, R Gevorkyan A, O Sukhikh S, K Gadzhiev N, Yu Pushkar D","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Staghorn nephrolithiasis represents one of the most complex forms of urolithiasis, with treatment approaches remaining a subject of ongoing debate among specialists. This study aims to assess the effectiveness and safety of oral chemolysis using citrate mixtures in treating staghorn urate nephrolithiasis. A prospective, multicenter cohort study was conducted from January 2023 to October 2024 among patients with CT-diagnosed staghorn stones of presumed urate composition (average urine pH less or equal 5.8, average stone density less or equal 650 HU, radiolucent on urogram or topogram) who received oral chemolysis with a citrate mixture containing citric acid, potassium bicarbonate, and sodium citrate (\"Blemaren\"). Patients were recruited from outpatient clinics and hospitals in Moscow. RESULTS: Of the 49 patients included in the study, 2 were excluded within the first 2 months. Complete stone dissolution was achieved in 30 patients (63.8%), while 17 patients (36.2%) eventually required surgical intervention. Among these, 4 patients (8.5%) achieved complete stone dissolution within 1 month of therapy, 18 patients (38%) within 3 months, and 8 patients (17%) within 6 months. Of the stones removed surgically, 12 (70.6%) were calcium oxalate, and 5 (29.4%) were uric acid stones. Consequently, the proportion of patients with non-calcium oxalate stones who did not achieve complete stone dissolution was 14.3%. Stone density was the only parameter that significantly influenced the likelihood of stone dissolution and the risk of surgical intervention (p<0.05). According to regression analysis, the likelihood of stone dissolution decreased by a factor of 1.012 with each unit increase in stone density, while the risk of surgery increased by a factor of 1.008 under the same conditions. CONCLUSIONS: The results of this study demonstrate that oral chemolysis for staghorn uric acid nephrolithiasis is an effective method and may serve as a viable alternative to surgical treatment, potentially reducing the associated risks of anesthesia and surgery for this patient group.</p>","PeriodicalId":23546,"journal":{"name":"Urologiia","volume":" 6","pages":"17-23"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Fosfomycin as antibiotic prophylaxis in men undergoing transrectal prostate biopsy: a systematic review of the literature].","authors":"N Bernikov A, V Govorov A, A Bagateliya Z","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Transrectal prostate biopsy remains the standard method for prostate cancer diagnosis, but it is associated with a high risk of infectious complications. In recent years, fosfomycin has been increasingly used as an alternative for antibiotic prophylaxis due to the increasing resistance of pathogens to fluoroquinolones, its good safety profile and ease of use. Results of several studies dedicated to the efficiency of fosfomycin are highlighted in this review. Fosfomycin demonstrates significant advantages as a drug for the prevention of infectious and inflammatory complications in patients after prostate biopsy, especially in case of increasing resistance to fluoroquinolones. Its efficacy, safety and ease of use make it an attractive choice and a reliable alternative in the context of increasing antibiotic resistance. Combination regimens with fluoroquinolones may be preferable for high-risk group.</p>","PeriodicalId":23546,"journal":{"name":"Urologiia","volume":" 6","pages":"152-156"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Continental cutaneous extramural ileal outlet. 20-year experience. (Multicenter study)].","authors":"B Ochcharkhadzhiev S, P Darenkov S, Abol-Enein H Abol-Enein H, A Shokeir A, B Ochcharkhadzhieva A, S Reshiev S, A Kostoeva Z, B Ochcharkhadzhieva M, Sh Yasaev R, R Nashkhoev M, Kh Vashaev B, I Astamirov Kh, D Bataev M, Kh Midaev M, S Dzhanaraliev D, Kh Amaeva Kh, H Dudayeva H","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>Analysis of the results of the formation of extramural retaining catheterization cutaneous stomas (outlets) during the implementation of heterotopic reservoirs from the ileum in the long-term period.</p><p><strong>Materials and methods: </strong>From 2001 to 2024, the formation of a heterotopic reservoir from the ileum according to Abol-Enein was performed in 161 patients (103 men, 42 women and 16 children). Primary urine diversion was performed in 138 patients, conversion - in 23. The technique consisted of creating a detubularized W-shaped ileal reservoir with the formation of an outlet and ureteral transplantation (inlet) using the extramural technique. A longitudinally narrowed segment of the ileum was used as a continental outlet.</p><p><strong>Results: </strong>A total of 157 patients (97.5%) were dry both day and night. In 4 patients (2.5%), in the early years of mastering the surgical technique, failure of the urinary continence mechanism was observed: two of them underwent open revision and outlet reconstruction, the remaining patients preferred a permanent catheter. Two patients (1.2%) had stoma stenosis: in 1 of these cases, Y-shaped plastic surgery with a skin flap was successfully performed; bougienage of the external part of the outlet was effective in another one. In two patients (1.2%) with an extramural outlet, reservoir retention and the impossibility of catheterization were observed. Percutaneous drainage under ultrasound control became a solution to the problem and free catheterization became possible later. The difficulty in passing a catheter through the outlet was detected in 3 patients (1.9%), they also refused reconstructive intervention in favor of a permanent catheter for various reasons. It has been established that the cause of difficult catheterization is an outlet angulation and/or reservoir ptosis. The angulation can be prevented by using an adequate outlet length and proper reservoir fixation.</p><p><strong>Conclusions: </strong>The extramural outlet according to Abol-Enein provides high efficiency of the heterotopic reservoir and satisfactory quality of life for patients in the near and distant periods, for both primary and conversion urine diversions.</p>","PeriodicalId":23546,"journal":{"name":"Urologiia","volume":" 6","pages":"84-89"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Development of a Deep Learning-Based System for Supporting Medical Decision-Making in PI-RADS Score Determination].","authors":"He Mingze He Mingze, E Enikeev M, T Rzaev R, M Chernenkiy I, V Feldsherov M, Li He Li He, Hu Kebang Hu Kebang, V Shpot E, V Glybochko P","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>to explore the development of a computer-aided diagnosis (CAD) system based on deep learning (DL) neural networks aimed at minimizing human error in PI-RADS grading and supporting medical decision-making.</p><p><strong>Materials and methods: </strong>This retrospective multicenter study included a cohort of 136 patients, comprising 108 cases of PCa (PI-RADS score 4-5) and 28 cases of benign conditions (PI-RADS score 1-2). The 3D U-Net architecture was applied to process T2-weighted images (T2W), diffusion-weighted images (DWI), and dynamic contrast-enhanced images (DCE). Statistical analysis was conducted using Python libraries to assess diagnostic performance, including sensitivity, specificity, Dice similarity coefficients, and the area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>The DL-CAD system achieved an average accuracy of 78%, sensitivity of 60%, and specificity of 84% for detecting lesions in the prostate. The Dice similarity coefficient for prostate segmentation was 0.71, and the AUC was 81.16%. The system demonstrated high specificity in reducing false-positive results, which, after further optimization, could help minimize unnecessary biopsies and overtreatment.</p><p><strong>Conclusion: </strong>The DL-CAD system shows potential in supporting clinical decision-making for patients with clinically significant PCa by improving diagnostic accuracy, particularly in minimizing intra- and inter-observer variability. Despite its high specificity, improvements in sensitivity and segmentation accuracy are needed, which could be achieved by using larger datasets and advanced deep learning techniques. Further multicenter validation is required for accelerated integration of this system into clinical practice.</p>","PeriodicalId":23546,"journal":{"name":"Urologiia","volume":" 6","pages":"5-11"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Modern optical non-invasive technologies in diagnostics of urological diseases. Literature review. Part II].","authors":"V Popov S, G Guseinov R, V Potapova E, V Sivak K, V Dremin V, V Perepelitsa V, A Lelyavina T, V Dunaev A","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The publications devoted to studying the diagnostic capabilities of fluorescence spectroscopy, confocal microscopy and optical coherence tomography in urological patients are analyzed in this part of the review.</p>","PeriodicalId":23546,"journal":{"name":"Urologiia","volume":" 6","pages":"134-141"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Tandem ureteral stenting].","authors":"B Mantsaev A, G Martov A, S Andronov A, S Serikov S","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Ureteral stricture is a common urological problem, which has a high recurrence rate. The efficiency of treatment is affected not only by the etiology of the stricture, its length, the technique of the surgical procedure (open, endoscopic, laparoscopic, robot-assisted), but also the method and duration of ureteral drainage in the postoperative period. Classical approach using one internal stent does not provide optimal ureteral lumen at the site of intervention, while special stents for endopyelotomy (with larger segment at the area of stricture) can lead to ischemia and prevent adequate urodynamics. The insertion of two internal stents (tandem stenting) allows to achieve adequate urine passage due to the so-called \"useful\" space between the stents and the natural ureteral lumen, a low probability of ischemia due to the absence of circular pressure on the stricture area, as well as a sufficient diameter to maintain the internal lumen. In this article, publications devoted to tandem ureteral stenting are reviewed and our own results are presented. Tandem ureteral stenting is an effective and safe method and, in the future, can expand the possibilities of minimally invasive treatment of patients with ureteral strictures.</p>","PeriodicalId":23546,"journal":{"name":"Urologiia","volume":" 6","pages":"165-171"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Mens health preservation: gender-specific features of disease prevention and choice of program solution].","authors":"A Kamalov A, A Gabbasova L, Yu Nesterova O, A Bozhedomov V, M Drapkina O","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The protection of mens health as a concept is currently only beginning to emerge in most countries, but the belief about the need to develop this area is being discussed more and more often by leading representatives of the medical community. Interest in the issues of mens health protection and gender approaches to health assessment in the health system has increased significantly, primarily due to the higher mortality rate of the male population, as well as lower life expectancy at birth (LEB). Compared to women, men are more vulnerable to many diseases that affect the quality and duration of life, but they are poorly motivated to maintain health, rarely turn to doctors for prevention. Many important steps have already been taken in this direction: pilot projects are being created all over the world, interdisciplinary platforms are being developed, specialists are being trained and legislative regulation is changing. The joint work of doctors in the field, as well as the development of national programs, will help to overcome the gender gap in life expectancy between men and women by promoting a holistic and orderly approach to mens health.</p>","PeriodicalId":23546,"journal":{"name":"Urologiia","volume":" 6","pages":"125-132"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Non-biological simulator for training intrarenal navigation during retrograde intrarenal surgery].","authors":"G Guliev B, U Agagyulov M, E Talyshinsky A, A Andrianov A, N Allahverdiev O, S Fundament A","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The most complex stage of retrograde intrarenal surgery (RIRS) is intrarenal navigation in the collecting system. The existing simulators for training have drawbacks or are unavailable, so a non-biological simulator was developed to teach the technique of this procedure.</p><p><strong>Aim: </strong>To provide the characteristics of the developed non-biological simulator for teaching the RIRS technique and the results of its testing.</p><p><strong>Materials and methods: </strong>We have developed a non-biological simulator for teaching the RIRS technique, the main part of which is a quadrangular box of 60 30 cm, having special internal recesses for models of the bladder, ureters and 3D-collecting system, as well as transparent and dark covers. The simulator has three or more pairs of 3D-models of the collecting system. After the insertion of the ureteral access sheath and instructions from an expert urologist at the RIRS, a training session with 15 urologists (10 without experience and 5 with experience in endourology, except for the RIRS) was carried out. Intrarenal navigation with inspection of all groups of calyces was initially performed with the simulator closed with a transparent top, while the trainee looked at the 3D model of the kidney itself. Then the training continued with an opaque top and the physician looked only at the video monitor. Ten navigations were performed on each side. The navigation time from the moment of insertion of the flexible ureteroscope into the renal pelvis was determined.</p><p><strong>Results: </strong>A total of 268 intrarenal navigations were performed (134 on each side). Thirty-two (10.7%) tests were not completed, since 6 and 4 urologists stopped the training on the 8th and 9th tests, showing the minimum navigation time. For all trials, the average navigation time was 155.8+/-92.4 s, and it significantly decreased from 252.6+/-107.0 in the first to 94.5+/-34.0 s in the last attempt (p<0.001). In experienced physicians, the navigation time decreased from 185.0+/-52.4 to 85.6+/-26.8 s (p=0.045), while in inexperienced urologists from 290.5+/-109.6 to 96.7+/-35.4 s (p<0.0001). The experienced urologists demonstrated better results in the initial test compared to the inexperienced group (185.0+/-52.4 s vs. 290.5+/-109.6 s, p=0.037), but after training, the navigation time in the final test did not differ (85.6+/-26.8 s vs. 96.7+/-35.4 s, p=0.984).</p><p><strong>Conclusions: </strong>Our non-biological simulator allows to improve surgical skills in RIRS. The obtained results show that both experienced and inexperienced urologists significantly improve their skills in the navigation in the collecting system.</p>","PeriodicalId":23546,"journal":{"name":"Urologiia","volume":" 6","pages":"29-36"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Long-term functional results of artificial urinary sphincter implantation in men].","authors":"A Tomilov A, I Veliev E, N Golubtsova E","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Urinary incontinence after radical treatment of prostate cancer causes a significant negative impact on the quality of life. Patients with severe urinary incontinence are most commonly treated with artificial urinary sphincter (AUS) placement.</p><p><strong>Aim: </strong>To evaluate the functional results of AUS implantation in patients with severe urinary incontinence at long-term follow-up.</p><p><strong>Materials and methods: </strong>Between 2004 and 2023, the AUS was implanted in 62 patients with severe stress urinary incontinence. Urinary losses were assessed using a bladder diary. No need to use pads or use of no more than 1 safety pad per day (\"social continence\") was considered a success, while use of no more than 2 pads, or a reduction in urine loss of more than 50% was regarded as an improvement.</p><p><strong>Results: </strong>The mean patient age at the time of AUS implantation was 67.4+/-8 years. Urinary incontinence was most often a complication of radical prostatectomy (61.3%). A history of radiation therapy, previous treatment of urethral stricture, and surgical procedures for urinary incontinence were noted in 14.5%, 48.4%, and 19.4% of patients, respectively. The median follow-up was 73.5 months (IQR 14.8-118.3 months). There was a significant decrease in median urine loss from 900 mL (IQR 700-1100 mL) to 7 mL (IQR 0-35 mL; p<0.05), and a decrease in the number of pads used per day from 7 (IQR 6-8) to 1 (IQR 0-2; p<0.05). The criterion for successful implantation was met in 69.4% of patients, while 43.5% of patients did not use pads. According to the correlation analysis, concomitant diabetes mellitus, history of radiation therapy, surgical treatment of the urethral stricture or urinary incontinence did not have any significant effect on functional results. In addition, there were no cases of AUS revision.</p><p><strong>Conclusions: </strong>AUS placement in patients with severe stress urinary incontinence allows to achieve satisfactory functional results during long-term follow-up.</p>","PeriodicalId":23546,"journal":{"name":"Urologiia","volume":" 6","pages":"90-94"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A multicenter, randomized, parallel, controlled, prospective, open-label study of the efficiency and safety of bovhyaluronidase azoximer in combination therapy in patients with lower urinary tract symptoms due to benign prostatic hyperplasia].","authors":"I Rasner P, S Al-Shukri A, S Shormanov I, Kh Tazhetdinov O, V Maksimova A","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Lower urinary tract symptoms (LUTS) occur in 90% of middle-aged, elderly and senile men and are usually associated with benign prostatic hyperplasia (BPH). The prevalence of BPH and its negative impact on all aspects of a man's life force modern scientists to search for optimal and safe treatment strategies.</p><p><strong>Aim: </strong>To evaluate the efficiency and safety of bovhyaluronidase azoximer (Longidaza, lyophilisate for injection and rectal suppositories 3,000 IU) in combination with the alpha-blocker tamsulosin in the treatment of patients with LUTS associated with BPH.</p><p><strong>Materials and methods: </strong>A total of 229 patients with LUTS associated with BPH were included in the study. They were randomly divided into an experimental group (n=118) and a control group (n=111). Patients in the experimental group received the drug Longidaza in 2 dosage forms together with tamsulosin, while in the control group, tamsulosin was administered as monotherapy. The evaluation was carried out in outpatient settings and included five timepoints. The duration of follow-up of patients throughout the study was no more than 138 days.</p><p><strong>Results: </strong>There were no differences between patients in the experimental and control groups in terms of baseline characteristics and duration of LUTS due to BPH (1.51+/-1.04 vs. 1.46+/-0.85 years, respectively). In the experimental group, there was a significantly more pronounced decrease in the level of symptoms according to the International Prostate Symptom Score (IPSS) at 60 (+/-1) and 130 (+/-3) days from the start of therapy compared to the baseline level (p = 0.031 and 0.004, respectively). Throughout the study, total prostate volume moderately decreased in all patients. According to the analysis of covariance, a significantly more pronounced decrease in the total NIH-CPSI score was also observed in the experimental group. In addition, in the main group the quality of life increased by 85.71%, while in the control group the positive dynamics was in 71.43% of cases. During laboratory examination it was found that the total PSA level remained virtually unchanged in patients of both groups, There were 5 adverse events (AE) in the experimental group and 14 in the control group, and none of the AE prevented the patients from continuing to participate in the study.</p><p><strong>Conclusion: </strong>Our results indicate greater efficiency and safety of combination therapy with Longidaza and tamsulosin in patients with LUTS due to BPH compared to monotherapy with tamsulosin.</p>","PeriodicalId":23546,"journal":{"name":"Urologiia","volume":" 6","pages":"65-75"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}